I’m guessing this news, and it IS news today, isn’t going to startle you. Smoking’s bad for us, whether we’re choosing to do it or getting second-hand smoke from others who do. Laws restricting where we can smoke were intended to reduce the harms of passive smoking and today Cochrane has published the most robust evidence yet indicating that they succeed in doing this and particularly in cutting the risk of heart disease. Smoking bans, it seems, are good for us all, with the biggest gains for non-smokers.

Is passive smoking really a big deal?

The World Health Organization estimates that there are around six million deaths each year from tobacco-related diseases; in adults, this is one death in every ten, worldwide. 600,000 of these deaths are from the effects of passive smoking.

Ireland was the first country to ban indoor smoking in all public places, back in 2004, and many other countries and regions have since done so, both to protect non-smokers from the effects of second-hand smoke and to support smokers who want to quit. It’s a change that’s gathered pace and we need research to keep up with it, to demonstrate if such legislation is having the intended effects.

What’s the evidence that smoking bans work?

Today’s new evidence comes from a Cochrane review, which has brought together the best available evidence on the effects of laws banning smoking. The first version of the review was published in 2010 and has now been updated, to bring in newer research. The review, carried out by a team funded by the Health Research Board in Ireland, looked at the effects of legislative smoking bans on death and disease from exposure to second-hand smoke and on smoking behaviour. It includes 77 studies (including 65 new ones) looking at populations of smokers and non-smokers from 21 countries. 44 studies looked specifically at cardiovascular disease (to do with the heart and blood vessels).

Here’s what they found:

Consistent evidence of a reduction in heart disease and in deaths from smoking-related illnesses

The greatest drop in hospital admissions for heart disease was in populations of non-smokers

Five of six studies found an association between smoking bans and fewer hospital admissions for stroke

Some evidence of a reduction in active smoking in pregnant women and so reduced passive smoke exposure for their babies. The impact on newborn babies’ health is unclear

The impact on respiratory illnesses is unclear

The impact of smoking bans on smoking behavior (how many people smoke and how much) is unclear

How good is the evidence?

Smoking bans are associated with fewer hospital admissions for heart disease in non-smokers

There are no randomized trials on legislative smoking bans and so the review draws on other types of research which can only show associations between smoking bans and health outcomes, not establish that they have caused any improvements seen. Where other factors that might have an important effect, including other anti-smoking legislation and activities, the review team discusses this and explains where studies have made adjustments for them.

This updated review includes a much larger body of evidence than we had before. The reviewers found that, in particular, we can be moderately confident that national smoking bans reduce heart disease in non-smokers.

Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations. We now need research on the continued longer-term impact of smoking bans on the health outcomes of specific sub-groups of the population, such as young children, disadvantaged and minority groups.”

About Sarah Chapman

Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients.
A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

2 Comments on this post

Just putting bans on smoking is not enough to eradicate this bad habit but we really need to talk to those people who are indulged in this addiction so that we can make then understand that how bad it is for their health and as well as for entire family’s life which is directly or indirectly associated with that person.

However, all people are aware of the bad effects of smoking but we need to make then realize it by talking to an individual person involved in it.

Smoking generally has adverse health effects, because smoke inhalation inherently poses challenges to various physiologic processes such as respiration, heart attack, joint pain etc. Hence stop smoking it gives immediate as well as long term benefits to you and your loved ones.

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